310290_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qua

If
IL
Type of Visit: AE) Com ce Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: 00 County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: I r Title:
Onsite Representative: rN' ( L4 f 1 rr", I l <-/—
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Phone:
Integrator:
Certification Number: { 7 2-s-9
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
an to Finish Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
99
Non -La er
Da"X Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
Dr.. P,oult . Ca aci P,o
Layers
D Cow
Non -Dal
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Turkey Poults
Other
I
lReef Brood Cow
Other
Other
F
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [] No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes []No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes [—]No
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes L'J No ❑ NA ❑ NE
Page l of 3 21412015 Continued

Facility Number: - Date of Inspection:
NVaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �R k "L �P c L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z3
5. Are there any immediate threats to the integrity of any of the structures observed? 0 Yes No NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or env' onF�No
threat, notify DWR
7. Do any of the structures need maintenance or improvement? Yeso ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste strictures require ❑ Yes WN(o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
YNo
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
4Xo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
dNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
EfNo
❑ NA
❑ NE
the appropriate box.
❑ WUP [:]Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑/ o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [::]Yes No ❑ NA ❑ NE
Page 2 of 3 214120I5 Continued

Facili Number: -6 jDate of Inspection:U 4 1,
r
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
NA ❑ NE
�00
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
Yes
❑❑
l_dNA NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
[:]No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[ ] Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
I o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
CyNO ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
F!fNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ErNo ❑ NA ❑ NE
awr.nuuaaYwwa a�aaaaa.. - - / a awaar. • -
Reviewer/Inspector Signature: -_ �-`"�O✓'� Date: tT /; / f
Page 3 of 3 2/4/1015

���Divi'sion of Water Resources
Facility Number - �y 0 Division of Soil and Water Conservation
� Other Agency
Type of Visit: =outine
a Inspection Operation Review O Structure Evaluation p Technical Assistance
Keason for Visit: 0 Complaint 0 Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:1 Ub 0 Arrival Time: 4 Departure Time: ! t County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: % Title:
Onsite Representative: P I I< I e,—
Certified Operator:
Phone:
Region:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Design Current
Wet Poultry Capacity Pop. C*attle
Layer Dayx Cow
Design Current
C►opacity Pop.
canto Feeder
�_2r2i9 20
Non-La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
D , P,oul , Ca aci P,o , Non -Dairy
Layers Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
I M
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes El No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facie ' umber: - D Date of inspection: I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: -- (''� LL
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �_ 3 Z--
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [�]rNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes Ej No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? EYes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E:rNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EJ'No ❑ NA ❑ NE
maintenance or improvement?
1 i . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ENo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes o No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [D]No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes EfNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes EfNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
ElYes d�N
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Ot
21. Does record keeping need irn overnent? If yes, check the appropriate box below. 9Yes ❑ No
❑ Waste Application Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes WNo
o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili 'Number: -0 Date of Inspection:
[s
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Now ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
0'N0 ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Nan -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
r-
❑ Yes
No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No [],iZC
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency9
s!andlorany,�additi©nal re
[:]Yes [fNo ❑ NA ❑ NE
❑ Yes J No ❑ NA ❑ NE
❑ Yes Eal o ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes
[ o
❑ NA
❑ NE
❑ Yes
_C],1Qo
❑ NA
❑ NE
°y
V 3 l� s
r
f, �c�Cc �o fron ��'c4- so•`c� �asS 910��''j4�Q'1h
4- pF C`'.�c4!/
Reviewer/Inspector Name:
Phone:
Reviewer/inspector Signature:
-"
Date: 1l / 4 In.
Page 3 of 3
21412015

~ ivis""ion of Water Quality
Facility Number ICJ - �� Division of Soil and Water Conservation
'--�� O Other Age_cy
Type of Visit: Com nee Inspection Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency. O Other O Denied Access
Date of Visit:
�O IIL /��I
Arrival Time:
Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: �4 .p' cot, t'f _ Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design
Cattle Capacity
Dairy Cow
C*urrent
Pap.
can to Feeder j*V
Zw Non -La er I
Dairy Calf
Feeder to Finish
Design Current
Dr. P.oultz, Ca aci_ P.o ,
Layers
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Nan-Dai
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poult .
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
[—]Yes
0No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
FNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Ia
n
[Facility Plumber: - -Xq jDate of Inspection: G 1S—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E3, ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r--,Io 4� L 0.1 2-
Spillway?:
Designed Freeboard (in): 1 �� 5—
Observed Freeboard (in): 33 1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ETNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes E3-<o_ ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Rio ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E]�No
[DNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[E�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
d
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
VN
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking rop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ED"N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Wility Number: 3 f - 1- 7 0 jDate of Inspection: (e &(e IS-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes l] Wo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ZkYes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes C3'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑ No [ A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes Q-No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [Efl�o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
To
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface rile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNIP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
N
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
rNo
❑ NA
❑ NE
Comments (refer to question-ft Explain any YES answers and/or any additional recommendatioiii.or any other comments:"_'
Use drawings of facility to better explain situations (use additional pages as necessary):
jN4j records
�e� ��U� e S(,lr✓fir ci a.�t
CP
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q 10 7? 1-
Date: 6 %
2412014

Type of Visit: ompliance Inspection 0 Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:
f
Farm Name:,
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: ZM4Aeal
Certified Operator:
Back-up Operator:
Title:
Phone:
Region:
Integrator:
Certification Number: / 7 % T'9 2
Certification Number:
Location of Farm: Latitude: Longitude:
Design
Current
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
I
Dat Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P,oul_
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes JZ'No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes 4No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ONo
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes g o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Faeflity Number: Date of Inspection:
Waste Collection & Treatment
4. IS storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes j�/ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes TTV'' No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: rL
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes 0 No
❑ Yes Z No
❑ NA ❑ NE
❑NA ❑NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes jam/ `No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) 17
9. Does any part of the waste management system other than the waste structures require ❑ Yes VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes &No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
No
9No
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ��" No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facilitv Number: 42 -/)!w__1 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the perm ?
❑ Yes
No ❑ NA ❑ NE
A
21 Is the Tacility out of compliance with permit conditions related to sludge? If yes, check
[—]Yes
6No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
eEj No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[;dNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
TT
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
57q nzel�?111 4//71,0'
3Q�10/ (>�
7
ma-5
Reviewer/Inspector Name: Phone: �v
Reviewer/Inspector Signature: Date: l3
Page 3 of 3 V14120 1

G
Facility Nuinbei^
—J
�""
vision of Water Quality
vision of Sotl and,Water Conservation
her Agency
Type of Visit ,a —compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit'10Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Z22eparture Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = S = Longitude: = ° = 4 =
Ig
.- ,.._�, ;
Design Curoiif 'Design Current _ T � Destill
ign Current
Swine=wCapacgy Population 'et Poultry Capacity P..apulahon� Cattle` `' Capac ty Population
��
,. ❑ Wean to Finish ❑ La er I El Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
ElFarrow to Wean
_
El Dry Cow
❑ Farrow to Feeder
Dry Poultry;_ k .
�
El
Farrow to Finish
El La ers
tr ❑ Beef Stocker
ElEl
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
�
- �,� ❑ Turkeys
❑ T Poults
El
urkey
f'Structur
F ElOther � — mlier.o es
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes,�EfNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes,.EMo
❑ Yes-ErNo
❑ NA
❑ NE
❑ Yes —B No
❑ NA
❑ NE
12128104 Continued

FaciliNumber: - Date of Inspection:
' Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
9No ❑ NA ❑ NE
❑No ❑NA ONE
- Structure 6
❑ Yes J"No ❑ NA ❑ NE
❑ Yes '0 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes ONo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes _,E]�No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination? _01
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes L2'�To ❑ NA ❑ NE
❑ Yes j3 No ❑ NA ❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ YesAn"No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes eNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes .CjNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes -EfrNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes _[2-No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

]Facility Number; - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the pe t?
❑ Yes No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes [] No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes )ZNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes JZNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes P'No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes '�"No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ;3 No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes LzNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes /E� No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes o
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments:,
Use drawings of facility to better explain situations use additional pages as necessary)._
3
" w o [ netej e
Ief U_ S
3 10111
o.7� Inds ���reumd-,
Y/S/-/O Ply
!� d Ia-,
sh66e, 4501- 1 6" Q
-Anon
6r 56z4e leue_
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: — �L
Date: cg 71,11
2/4/2Oil

m �0 Division of Water Quality e yam,
tuber Q oil and Wa' iii Conservati Dtv�sion of Son .�
:.Q Other -:Agency a =� :'
Eactlkty Nu
(Type of Visit 4 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit rd<Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 61F.Arrival Time: O Departure Time: County:
tk%,_.P
Farm Name: - Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: l(/////� _ Integrator: _ rn�_
Certified Operator: Operator Certification 'Number:
Back-up Operator:
Location of Farm:
Region:
Back-up Certification Number:
Latitude: [= o = I [ « Longitude: = c = 4
Design" Current Design Current Design' Current
(Type of Visit 4 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit rd<Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 61F.Arrival Time: O Departure Time: County:
tk%,_.P
Farm Name: - Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: l(/////� _ Integrator: _ rn�_
Certified Operator: Operator Certification 'Number:
Back-up Operator:
Location of Farm:
Region:
Back-up Certification Number:
Latitude: [= o = I [ « Longitude: = c = 4
Design" Current Design Current Design' Current
�WetPoultryCapacity P:ulaho� Cattle "' sC p iyPo'"�
Swaney Capacity Populatton plahon op
a
_.
❑Wean to Finish
El Dairy
❑
Pullets
El Turkeys ❑Other
Turkey Points ❑
Cow
Calf
Beef Feeder
El Dairy Heifer
❑ D Cow
❑ Non -Dairy
El Beef Stocker
[EllEl Beef Brood Co
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑ Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ No
Cow
Calf
Beef Feeder
El Dairy Heifer
❑ D Cow
❑ Non -Dairy
El Beef Stocker
[EllEl Beef Brood Co
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑ Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ No
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑ Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes 1!�No
❑ Yes ONO
❑ NA
❑ NE
❑ Yes V`No
❑ NA
❑ NE
I2/28/04
Continued

Facility Number: � -- Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZfNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No ❑ NA ❑ NE
Strugture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: "I
Spillway?:
Designed Freeboard (in):
Observed Freebbard (in): aI
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
PNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed [:]Yes
tjNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
p No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
PrNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
VNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
J'No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
/ZNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or t 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
'PrNo
❑ Yes XNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes a No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes PNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �rNo
❑ NA
❑ NE
"raamT
nts(reer to_qments•Commfr.
Use ity t drawings`of facilo better explarn•situahons {nse addrtional,pages as necessary): i ..
jet
Reviewer/Ins ector Name �
p / -.` �x � . , <. .. ��.re Phone: — 79� •—
Reviewer/Inspector Signature: Date: jdff
Page 2 of 3 12128104 - Continued

Facility Number: Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes ZNo ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
?No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
91110
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
O No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
9 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
gNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
/
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
PNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
FfNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ONO
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
o �7��
I
Neee/ fe rc cwk w
it ,6,61
�2/fZ/y
lets /i?6e- C;;ood.
xt
J uZ17, 1 f q_
furvr�
Page 3 of 3 v 12,128104 `-

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit PrRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
i -
Date of Visit: %� & j Arrival Time. Departure Time: County: l Region.�t
Farm Name:/ L� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
A
Phone:
Phone No.
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: E o ❑ Longitude: ❑
Design Current Design
Current
Design
Current
Swine Capacity Popetulation WPoultry C►apacity
Population
Cattle Capacity
Population
❑ Wean to Finish ❑ Layer
El Dairy Cow
ElWean to Feeder 1 10 Non -Layer I
El Dairy Calf
ElFeeder to Finish
El Dairy Heifer
ElFarrow to Wean Dry Poultry
El Dry Cow
❑ Farrow to Feeder
❑ Layers
ElNon-Dairy
Farrow to Finish
ElNon-Layers
ElBeef Stocker
rEl Gilts
❑ Beef Feeder
❑ Pullets
Boars
❑ Beef Brood Cowl
❑ Turke s
Other. ❑ Turkey Pouets
❑ Other 10 Other I
umber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes PNo
❑ NA ❑ NE
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes 4No
❑ Yes ANo
❑ NA ❑ NE
❑ Yes A No
Cl NA ❑ NE
12128104 Continued

- Facility Number: ; ' Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes O No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Q No ❑ NA ❑ NE
St I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): '
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �`No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ?�No ElNA ElNE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes X
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes] No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
P6 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
r
10 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
f No
❑ NA
❑ NE
Comments (refer to question #): Explarn,any YE t ,�,� -,
S answers an any recommendations or anv� other�eomments
Use drawings of facility to better explain situations.addieional pages as necessary) ` f:
�- sj C� C►' l�
Reviewer/inspector Name i` '-e Phone:i C�e
Reviewer/Inspector Signature: Date:
12 8/04 Continued

r
Facility Number: Date of Inspection
Recruired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes I EJ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ;No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[2No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
0Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
2 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ETNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
.❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
El No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
[--]Yes
F'] No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Jn No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
A— cf
rrb,
2 r14- 71 /lIzz 0- 111<�-
'' e' . e.1 ::,>I--27IC-e- )
c 1 r �r��� aP
13) Va ceDo
12128104

Division of Water Quality
=Facifityumber 31 o?gfj O Division of Soil and Water Conservation
Q Other Agency
Type of Visit compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit _P Routine O Complaint O Fallow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: —Arrival Time: I 47t fJ d Departure Time: r County: /`L Region:
Farm Name: / S
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Gilts
Other
❑ Other
Latitude: a o
Owner Email:
Phone:
Phone No:
Integrator• j2`�
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer i
❑ Non -Layer L-
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Longitude: ❑ ° = ' ❑
Design Current.
Cattle Capacity Population .
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heife)
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: ".
1
Dischames & Stream impacts
t 1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
t; a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
r
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ NA
❑ NE
❑ Yes
No
:❑ NA
❑ NE
12128104
p
` Continued
A
i

Fac!"Ny Number: / dye Date of inspection / Q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
�
0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
S_tyicture 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
J�lNo
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
W'No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
-No El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
T
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes,
❑ NA ❑ NE
maintenance/improvement?
J�21Vo
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
l--
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑.110
/[;�No
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? El Yes
/Pi'Ro
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
k No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Level? ery ylel�
/u4a J
/fer., cc,,en
f!pu14' e�rviT3 Gs/v��S o�G��
Reviewer/InspectorName �• UW Phone:AXI -
Reviewer/Inspector Signature: Date: gE / .
cmf Yf{/cis 12128104 " Continued
ca

Type of Visit 0-ftmpliance inspection
Reason for Visit101koutine O Complaint
Date of Visit: IW.S 10f2l Arrival Time
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
0 Operation Review 0 Structure Evaluation 0 Technical Assistance
0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access- l
Departure Time: County: Region: wI 6
Facility Contact: Title:
Onsite Representative:
144 z ol.X
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator•
Operator Certification umber:
Back-up Certification Number:
Latitude: = o = Longitude: ❑ o = 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer I-.. -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
Other than from a discharge?
❑ Yes oNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
eNo
❑ NA
❑ NE
12128104 Continued

Facility Number:% Date of Inspection '
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: �crs
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes ;3N o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
S. Are there any immediate threats to the integrity of any of the structures observed`? ❑ Yes j�l'No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes +Pfo ❑ NA- ❑ WE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �o ❑ NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes T,:�Ko ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P11"o ❑ NA ❑ WE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) 4h/
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZNo
❑ NA
❑ WE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L?'No
❑ NA
❑ WE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
P No
❑ NA
❑ WE
17. Does the facility lack adequate acreage for land application?
❑ Yes
O No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
,YJ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary)-
Reviewer/inspector Name ��� U f !�� �,� Phone:
Reviewer/inspector Signature: / Date:
Page 2 of 12 8/04 Continued

Facjility Number: — Date of Inspection I Z : G
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis El Waste Transfers [I Annual Certification
El Rainfall El Stocking ❑Crop Yield 120 Minute Inspections [:]Monthly and 1" Rain Inspections ��Veather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ONo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
PNo
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
21VA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
gNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
,ENE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EINo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
'
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ONo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
P17o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ YesQ"tqo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑Yes
!d No
❑ NA
❑ NE
Additional Comments and/or Drawings:
cl LO a • q
%6 /7�6�
A ,5
Ar eo h ,
Page 3 of 3 12128104

OitruV - �- - a -✓ .-. �, � „
p v�sron ater:
'� €` ` Q'D1viSlon Of,St1d 8nd W�ateFsCOnSerVatttllt
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 91,outine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Mj;LO Tune: :.
Not Operational Q Below Threshold
Permitted J�Kejrdfi ed 0 Conditionally Certified 3 Registered Date Last Operated or Above Threshold- ... �........ _..
Farm Name: ....� :.1��,�'1,....J.ilfd,�'.ft'�'.. .. Conty:..�t. ............... .......... ..........
Owner Name: L... �er
................ � Phone No: .. ................................
Mailing Address:.._. ........ ......... W . . . _._.�._ . W..... W__ _ �.__..
Facility Contact: .......................................................... ._........ Title: Phone No:
Onsite Representative: II Q ��.<!!L1. it �Yr ................... ...... Integrator:..._.20! ......
._................
_ ....._..
Certified Operator;O erator Certification Nwnber•
Location of Farm:
,Citwine ❑ Poultry ❑ Cattle ❑ Horse Latitude • d A& Longitude • 4 «
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Z N'o
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes 'Z<o
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes PMo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes .E!rNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 'ET90
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes '1 "v
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: lj ,-e u-..... .... .,..._.... .......... .................. .._....................... ........ ....... - -- •........... .....................
Freeboard (inches):
12112103 Continued

Facility Number: f — Date of Inspection
Z
5'' Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ON"o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 2rNo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ;R'No
8. Does any part of the waste management system other than waste structures require maintenancermprovement? ❑ Yes EKO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 2_1�0
elevation markings?
Waste Anulication
10. Are there any buffers that need maintenance/improvement? ❑ Yes 12No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes .0'lffo
❑ Excessive Ponding ❑ PAN El Hydraulic Overload ❑ Frozen Ground❑ Copper and/or Zinc
12. Crop type �Z � , , SG ) (lal2l , , /
13. Do the receiving crops differ with those designated in the Certified Animal Waste Managedent Plan (CAWMP)? ❑ Yes 'ERV0
14. a) Does the facility lack adequate acreage for land application? ❑ Yes J Alo
b) Does the facility need a wettable acre determination? ❑ Yes;RNo
c) This facility is pended for a wettable acre determination? ❑ Yes _QXo
15. Does the receiving crop need improvement? ❑ Yes 'M0
16. Is there a lack of adequate waste application equipment? ❑ Yes [J bw
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ,ETYio
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes EfffJo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes '0<0
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes eNo
Air Quality representative immediately.
onet(efnertquetto bne.t6ter FexpYES anweis andoan recommeadarhyo} ns or❑anFvieold hCeOrPcYom❑imeFntntsa.l r
KCtmnrw�r
,Use �ty plan scpas necessaNotes
P
Pi/iZue Azoe-i 6✓ S Cn i h �S'1 XzjQcnon ei"Zik
�1
remove ;ri�_roze;-e A,,
14e
/.Ai%` ISI�j ��s�{A �G`� � � GAY• t��l�Qr��� C f/�
y
�,:-a.-`1s"" 97-1,—'�U
s
Reviewer/LasPactor Name �`��
ReviewerAnspector Signature: Date: 6
12112103 Continued

Facility Number: 3% -�7 Date of Inspection
t
Required Records & Document%
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? �es ❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes 010
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ago
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ZCNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes ,INo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(id discharge, freeboard problems, over application)
0 Yes WNo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes R No
28. Does facility require a follow-up visit by same agency?
❑ Yes Rio
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes P40
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes 2<O
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

r
Facility Number / Z Date or visit: �� Z7 G2 Time:
rO Not Operational 0 Below Threshold
29 Permitted ® Certified [3 Conditionally Certified [3 Registered
Farm Name:
Owner Name: ����sC //Ls'���✓_ _ ,_
Mailing Address:
Date Last Operated or Above Threshold:
Count} ILt ._
Phone No:
Facility Contact: Title: Phone No::
Onsite Representative: AV4 e'er Integrator: %% "4,gst c✓
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' • u Longitude 0 �• 0
-Design '-Current '_Design'.Curient Design d..`Guirrent
Swine W Capacity..Pa nlatton Poiil Ga' achy Po ulati©e Cattle t. v.: : Ca actty Po'telation
® Wean to Feeder f _e 3 ❑ Layer Da'
❑ Feeder to Finish , w ❑ Non -Layer 1 ` ❑Non -Dairy
rw
❑ Farrow to Wean
ElFarrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
r ❑ Gilts "� x
❑ Boars TotalSSLW
Nnraber of La Dons 2• ❑ Subsurface Drains Present ❑ Lagoon area ID S rav Field Area 1,`
Hald�ng Pontfs 1;Sa1td Traps ❑ No Li uid Waste Management System
DischaEges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ LaQoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 � re? Structure 3 Structure 4 Structure 5
Identifier: ei'Ibf-_ .t
Freeboard (inches): 710 2
05103101
❑ Yes B-No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
ED-190
❑ Yes
6-9-b
`® Yes
014
RI.Ro
Structure 6
Continued

r
Facility Dumber: 3j — Z9
Date of Inspection !I UZ-
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes ®-No
❑ Yes [9vo
❑ Yes [S-N-0--
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
04+io
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
UINO-
12. Crop type h 17 , 6 ,"5
- -
I3. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
[moo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
M-No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
yu Yes
❑ No
16_ Is there a lack of adequate waste application equipment?
❑ Yes
[K-NO
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
Eivo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
M-No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[9-No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
U;#o
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
[4No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
Q-No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[4NO
24. Does facility require a follow-up visit by same agency?
❑ Yes
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
[Iu Yes
�P-NO
No
E3 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer t4,questl6n #) `E Plaln:any Y 5'iauswers'and/oir any rdcomatendations or any other.coinments
Lise:drawings of facility to:betterezpn sitnatinns: {use.addrt,onal'psgec as necessary) .` . [] Field Cory ❑ FinaI Notes j,., -
5F - 62A _-Maw 4 -4-ee daae-g-e re4,4&1 v- /7
fir" Tuck C 191P U io6 S ovF✓glGcvn 4a[W weed1f 4'q A,-
/kiVla.0 Ovf, ,,rrtcr s IAL e4 �ouf c p✓«011 ,�- i'e `ply e, (e. ►
a,Ve' xko of'r o6 di'Iw; u" Alt
Ad'h ee W&elf "241m i'mn,-4 LA.4,po n—
e.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: /
05103101 v Continued

A h
Facility Number: — Q Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes P-No
liquid level of lagoon or storage pond with no agitation?
27. Are there anv dead animals not disposed of properly within 24 hours? ❑ Yes ` ' o
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �o
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ZNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 94�lo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes M NTo
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover? ❑ Yes EPro
~Additional Comments. andlor._Drawiaigs: _
�lc5 f 'f'P' 9 yl l 14 fG.—f
66 7V GtwlG O� 4M1,1C4 �ipn G1v40,n74—
O5103101

Division of -Water Quality
r
Q Division of SoilandWater Couservation. '
0 Other Agency. _
Type of Visit /d Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency [Notification O Other ❑ Denied Access
F_ Facility Number ( ZQ p Date of Visit: ZS O Time: d G 1 Printed on: 7/21/2000
Q Not Operational O Below Threshold
❑ Permitted ❑ Certified /13 Conditionally Certifie�dr ❑ Registered Date Last Operated or Above Threshold: ........................
Farm Name: �
K /' "/� /U Je.� ...
V ..rJ v: S � V� Count ,,,,,,,,,, 11
OwnerName:.......... 11-1 L k oiel ..L.. j.'..1.G'................................................ Phone No:...........................---.........................................................
Facility Contact:
Title: ................................................................ Phone No:
Mailing Address: .............................. . ...........
Onsite Representative: ,,.., ' k."� f M .- ].I. " ''
................................... .............
Certified Operator:
Location 'of Farm:
Integrator :...!...'../.. . T�`11.........................
...... Operator Certification Number: ...... ............
© Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • f 66 Longitude • 4 at
Design. Current
Cainacity Poottlation
Wean to Feeder
SZ a 6
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design Current
Poultry Capacity Population Cattle Ca i d - -.-Pn ulation
❑ Layer ❑ Dairy
❑ Non -Layer I[] Non -Dairy
❑ Other
Total. Design Capacity
Total SSLW
lber`4Legot ns : Z ❑ Subsurface Drains Present ❑ Lagnan Area © Spray Field Area
� Hw _ 6 .v
-'ollding Ponds "/ Solid Traps ❑ No Liquid Waste Management System
_Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ,,dNo
Discharge originated at; El Lagoon [I Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes )zNo
b. if discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes E!fNo
c. If discharge is observed. what is the estimated flow in gallmin? 11 /G
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes j2rNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ;allo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ YesXNo
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:................................................................ ..................... .............. ....................... I ..... ....... ....................................
Freeboard (inches): 26,
5100 Continued on back

Facility Number: 3 / _ 2 21 Q Date of Inspection Z d Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �'No
• seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes PTfo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes 21$40
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
[]Yes P No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
[:]Yes
elevation markings?
�dNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes "E�No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
El Yes �No
12. Crop type F C-S G v t?) C. a rvt tAAI e � soy
)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes XNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15_ Does the receiving crop need improvement?
❑ Yes ,[�No
16. Is there a lack of adequate waste application equipment?
❑ Yes 'J� No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes (gNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes /E�No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes e[3'No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes )dNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes P&0
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 1j, Z No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ YesIFNo
24. Does facility require a follow-up visit by same agency? ❑ Yes PTO
J
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 11 No
Nd•yiolatidris:oi- deficiencies -were hb ea dtWing this;visit: - Y;oh will•teeeiye iio further -
cories oricience. about this visit: ................... •
Comments refer to "�uestion'#)- _E lain any answers and/or an _recommendations,oic pan other eo�ments. =
q xP y _Y y
Use drawings of facility to'better explain, situations., (uw-addttiorial pages as n _ -
k
4, rr s i s a t�a�-d „�� ao s�ri des - ��o ti��e�►��r z� A.
/g.. "e'- J e sa 7 b c'1, �l.s ?�MM 41V wC'sl e r [ a h can p'v 11 —1 .
Reviewer/Inspector Name Oli e- wa _ .aP ., ijr
Reviewer/Inspector Signature: Date: L5 . 5100

Facility Number: 3I Date of inspection /p ! J Printed on: 10/26/2000
'Odor Issues
• 26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 3 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes JZNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ONO
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes QINO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 0o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? El Yes TTT❑ No
I.
tional Comments-and/orDrawings:
J
5100

visi.on of Water Quahty ,
= Q Division of Soil and Water Conservation
= - ency,`
- �Oth.
-
-
Type of Visit X.Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit *Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit.: Z Time: Printed on: 7/21/2000
3 - �!d
0 Not Operational O Below Threshold
Permitted 0 Cee
Farm Name: ......1.... ►..
Date Last Opera, or Above Threshold: ....
Countv:....../...... k�4.a..............................
Owner Name: r..L.. I. ..... .................l..{..�P: i� .............................. Phone No:....................
............... ....... f...................................................................
/?) ..
FacilityContact:..1JU........................'....` . Title:........... ................................... Phone No:...................................................
MailingAddress: ............. ... ........................... Representative:.....................t ...................................... ..................................... ................... ..................... .... .....................
.....
..........
Onsite Representative:......tL1L..........._.........i..................................... Integrator:.... ....
�..............................................
s
..._ ......... .
Certified Operator:............ ................. ............. . r/ i Operator Certification Number: ...........
Location of Farm:
❑ Conditionally Certified [r Registered
---7 -f--y------ Is ....... ..............................
Swlne ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� �'� Longitude
Design, Current
Design
Current Design Curterit
id Po ulation
Poult
CatteCa
_ :Ca acr - := Po ulatlon
-
can to Feeder
L Oa
❑ Layer
❑ Dairy
Feeder to Finish
❑Non -Layer
❑Non -Dairy
Farrow to Wean
-
Farrow to Feeder
❑Other
Farrow to Finish
TOtal Ca Cl y
Gilts
_
Boars
Total SSLW-
5.u� - °Number of Ligeoi 10 Subsurface Drains Present ❑Lag -on Area JE3 Spray Field Area
- a
Hang Poisds / mi.d Traps:_ ❑ No Liquid Waste Management System _
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation?
❑ Yes krNo
Discharge originated at: El Lagoon ❑ Spray Field El Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/rnin?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Siructurc 2Structure 3 Structure 4 Structure 5
Identifier: ............. .................... .............................
_1
Freeboard (inches):4) 5100 1 bcAcL, (fyl�vv
❑ Yes ❑ No
;&A — —
❑ Yes ❑ No
[]Yes gNo
❑ Yes 0?�No
❑ Yes kNo
Structure 6
Continued on back

Facility - um� 1T?f6G Pate of Inspection t* Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes �10
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?~
[:]Yes XNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes D(No
\\
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes ko
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes *0
H. Is there evidence of over app ication? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes kNo
12. Crop type G
13. Do the receiving crops differ with hose designa ed in the Certifie Animal Waste Management Plan (CAWMP)?
❑ Yes UW
14. a) Does the facility lack adequate acreage for land application?
❑ Yes -E3390
b) Does the facility need a wettable acre determination?
❑ Yes f24Je'
c) This facility is pended for a wettable acre determination?
❑ Yes -EVNo
15. Does the receiving crop need improvement?
❑ Yes j;jhRLf'
16. -Is there a lack of adequate waste application equipment?
❑ Yes 014e-
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes "
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ._8&a--
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes -5?No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes JSI&In-
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes TB�No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes _5jNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes VNo
24. Does facility require a follow-up visit by same agency? ❑ Yes j(No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes RN_0
�'Vo violatiotis:or defckodos •Wre noted- d4firig �bis:visit' • Y:oi1 will reeM*ce Rio; further
correspondence. about_ this Yisit...
omments.(refer to question #): -Explain any YES answers -and/or any recommendations or any other coinments
>e:dzawings of facility to better explain situations (use additioii pages as necessary}oy
AL
P; Z d C
Reviewer/Inspector Name --7 IlP )a /��/ Ivl1p
Reviewer/Inspector Signature 1 V///zf/� .1 Date:

s r`
Facility Number: — Z Date of Inspection I J JkLigs 6 Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes KNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? Cl Yes Mo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �'LN0
roads, building structure, and/or public property) %
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes )-No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes �'No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ;.No
32. Do the flush tanks lack a submerged fill pipe or a permanenUtemporary cover? 0 Yes ❑ No
Additional Comments and/orDrawings: ry
J
5100

Divisions of Soil and -Water Conservation `QperaEion Review ,
s 0 Division of Soil and:Water.Conservation xCompliance Inspechoii
Dirision.of Water Quality Comphanee Inspection '
�.
' jM;Other Agency,- Operaiaon Review;'
[ID Routine Q Complaint 0 Follow-up of DWQ inspection O Follow-up of DSWC review O Other _
Facility Number Date of Inspection
Time of Inspection ,''' 24 hr. (hh:mm)
Of Permitted © Certified 13 Conditionally Certified 13 Registered JE3 Not O erational Date Last Operated:
Farm Name: .1�.'--i15County ....... javiin.....................................................
Owner Name:.... ............. ..[filJ.ft��i'.--.......1.1 �f................................................:.. Phone No:....../.11..`..7.g.."...7..1JY..........................
Facility Contact: ....................................i + ...................... Title: ......... 04J�t....................... Phone No:
MailingAddress: 7..1�. ......Sumr�rr r.....1 0............................................pinX...1- J.1....I... ................................... .?.z,.:.
Onsite Representative:........................................................................................................... Integrator: ...... l.:. UI- 9 F, Y.....]`
Certified Operator: ..... M i 4.................. (.� i.{,..................................... Operator Certification Number: ...... 1. 72,5..............
Location of Farm:
r,V
r........................................................................................................................................................................................................................................................................r
Latitude • ' 4 Longitude • 6 C6
.. _ _.
Design Current ' `Design_, Curren. Design Current
Swine_ Capacity Population. 1?ou.,try --. Capacity -..Population Cattle Capacity Population
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of La goons, ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
:.
HoldingPonds /.Solid Traps ❑ No Liquid Waste Management System
Disci & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ElLagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min'!
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): .............2.5............ ...........Z..
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes No
❑ Yes �] No
❑ Yes [VNo
❑ Yes [I No
❑ Yes No
❑ Yes �4 No
Structure 6
❑ Yes �l[Ylo
Continued on back

i.
✓ Faci ity Number: 31 — Zqa Date uf' lusperticrn
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes [(No
(If any of questions 4-6 was answered yes, and the situation poses an
10 immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? Ij Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenatice/improvement? (Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes VNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes '&No
11. Is there evidence of over application? []Excessive Ponding ❑ PAN ❑ Yes XNo
12. Crop type #'LV Jt_
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
5d No
b) Does the facility need a wettable acre determination?
Cl Yes
tgNo
c) This facility is pended for a wettable acre determination?
❑ Yes
�KNo
15.
Does the receiving crop need improvement?
04 Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
Dq No
Re uired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
'R No
l8.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) -
[:]Yes
JdNo
19_
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
WNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
b4 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
D4No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes a No
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes kNo
24. Does facility require a follow-up visit by same agency? ❑ Yes ( No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
yiglatigris'oi•- clef ciertcies •were h6fed. during phis;visit; - Y:oit will•eeeeive Rio fukthetr
correspondence_ A' A this visit_ • ... .
Comments (irefer to'questton #} Explain any YES answers antd/or any recommendations or:anygother con4ments
Use drawings of facility to betterbexplam situations (use a, di:aonal pages as neces"sary)47.
y
7. 001% o11 scccu,S i -o— c+.(;mS c.�[ a ��-� �otGOaY15 c;+'t Yke p A`
ike_r;r P'Pe_ Jr P4c I, kefzae Pull o-Z i -r�n� . i (�
4 Fief p n (� fit. c�e rJS t�v G roc caJ� c� ),, ) , c -nd. �e scaL rl � f 't'"r'1 Pcswc, Li kLee—
l�tec �',�'1" JI'Mk, l� ui�tr�'Iei1t5 ��' - e.sar t!/siS� j. I fan pe�acre� or
iJho # si 5 ftx�Lj
NIQ.Ke, fue tvi'nc\ coops �'P p>~iori y dilt� ��bl� s �►� p-A
Reviewer/Inspector Namey. aM
Reviewer/Inspector Signature: Date: f Z— 7_ _ 9
3/23/99

a-
Facility Number: — [late or inspection fz'
Odor Issues
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [)(No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Z No
roads, building structure, and/or public property)
29, Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes EI(No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes [(No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 5No
�bo the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional, ominents:aif _or rawrn
3/23/99

[3 Division of Soil and Water Conservation [3 Other Agency
63 Division of Water Quality
UR Routine 0 Coni0aint . 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number
Time of Inspection BT9= 24 hr. (bh:mm)
Megistered NCertified 13 Applied for Permit OPermitted 10 Not Operational I Date Last Operated:.,,,.,,,,,.
Farm Name:...... IJA.Lsti� ..... .............................................. County:,; ... D .01-k... ...... ........................ I .... .......................
OwnerName: ....... Pk ...... ........ ............ ........ K�ZAkc .............................................. Phone No:_(910 .. Aarz.Ow ............................................
FacilityContact: ............................................................................... Title: ................................................................ Phone No:.....----..........................................
MailingAddress: ... 2. ...................................................... ... &JAV(14 .... A& ............................................. ......
OnsiteRepresentative:........ hu-4P.&P-1 ..... &4K ......................................................... Integrator: ....................................................... I ...............................
Certified Operator................................................................................................................ Operator Certification Number:..................
Location of Farm:
Latitude Longitude
"D' esign, Current*::�,�
e5si t sign Current D urren
wine y..a.
C pacity P 4tion, Poultry opuL apacity.loptilation-. Cattle',,'
Wean to Feeder
52.00
❑ Feeder to Finish
❑ Farrow to Wean
0 Farrow to Feeder
0 Farrow to Finish
❑ Gilts
❑ Boars
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: [I Lagoon 0 Spray Field 0 Other
C�
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
0 Yes El No
0 Yes IZI No
0 Yes
[51 No
0 Yes
[R] No
0 Yes
[A No
0 Yes
10 No
D Yes [Z No
0 Yes EW No
0 Yes f9 No
El Yes 6l No
Continued on back

4
E
FaciRty Number: — t5
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,tlolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2
Identifier: 1 Z-
Freeboard (f ): ............' �.�............. ........... .�.:. 7.............
10. Is seepage observed from any of the structures?
❑ Yes ® No
❑ Yes JR] No
Structure 3 Structure 4 Structure 5 Structure 6
❑ Yes M No
11. Is erosion, or any other threats to the integrity of any of the structures observed'? ❑ Yes ® No
12. Do any of the structures need maintenance/improvement? Yes 01No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ) "
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes M No
Waste Application
14. Is there physical evidence of over application'? ❑ Yes fgNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ) _
15. Crop type .......... N:Sw.f................................................•-............................................................................--..--..._.._....................................._..._......_..
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes Lf'No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes 14 No
18. Does the receiving crop need improvement? PO Yes ❑ No
19. Is there a lack of available waste application equipment? ❑ Yes ® No
20. Does facility require a follow-up visit by same agency? Cl Yes ® No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
22. Does record keeping need improvement? Yes ❑ No
For Certified or Permitted Facilities Onl
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes 93 No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes P No
25. Were any additional problems noted which cause noncompliance of the Permit'? ❑ Yes P9 No
0 No.violations or deficiencies. were note'd-during' this. visit. receive no further
correspondence about this. visit:: ; : :..
Cotntnents (refer' o;questian #):.;Explain any YES answers andfor`any recom mendations;ar any, other comments "
b k
Use drawings of facility fo better'eirplaiti situations. -(use additional pages as necessary)
�f
{Y. Co,*nLA_e FtscVe
l
I.1
x� Caritc.`L�� �# S�av4f� �� >t3f� �n % 4�ra~i yttodj 1
ri 11�R-L �0, s o,46 bP . {
�Ia� {�ar euc� g►roW : r� �5on. `tom c WYzL� �c � �-
1
�; tettii -ra.�e � i i S�Yn� 1^�Cw`� T �' w► i
Ab 6 setrvtt��nt WljP Sh.4 iA� e k,,, ber, Yde- C"t
7/25/97id
Reviewer/Inspector!Name''€
Reviewerllnspector Signature: Date:

Routine
of
I Facility Number 31 290 I
0 Registered ® Certified © Applied for Permit ® Permitted
flow -up of DSWC review Q Other
Date of Inspection 1121197
Time of Inspection 1fl45 24 hr. (hh:mm)
113 Not Opera Date Last Operated:
Farm Name: Pj=-. .U,5( 1Ar.'.&.Nuxaeiry.................................................. .............. County: Djuglint................................................ Vdt.Q.........
OwnerName: WCblp4 .................................. l,!' weir........................................-----............ Phone No: PjQ::298.-.0.35 ..........................................................
Facility Contact: 1lfiehad.AWg r............................................... Title: Oyma................................................ Phone No:...................................................
Mailing Address: Z582.F.NC.14................................. ... H0JA1AYXC-NC............................... Z8iS1.8.............
.................................................... .......................
Onsite Representative: Mieuel.101gr............................. , Integrator: MU rFhYFAMjjyFRrj=.......................
Certified Operator:,del JL...........................IY.Gllcx......................... ...................... Operator Certification Number: 172,5.Q.............................
Location of Farm:
Latitude 34 " 58 1 43 u Longitude 77 " ®' S3 K
- - ;Design Current -
Swine Capacity Population
® Wean to Feeder 5200
❑ Feeder to Finish
Farrow to Wean
Lj Farrow to Feeder
Lj Farrow to Finish
is =
Boars
Poultry; T= Capacity Pop
wit = Design -Current
�hon ;Cattle - _ _ -. Capacity. Population'
5,200
156,000
` Number of Lagoons 1 Holding Ponds: 2 ❑ Subsurface Drains Present 10 Lagoon Area ❑ Spray Field Area
K s " ❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
2. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min.)
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ❑ No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ❑ No
7/25/97
Continued an beck

Faciliti.kN umber: 31— 290
R. ,Are tht-r-e lagoons or storage ponds on site which need to be properly closed?
❑ Yes
❑ No
Structures a oons Holdin Ponds Flush Pits. etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
® Yes
❑ No
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: 1...................................
Freeboard(ft):..............1.5.4...........................2.3............_......................................
10. Is seepage observed from any of the structures?
❑ Yes
❑ No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
❑ No
12. ' Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
❑ No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
❑ No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type.........................................................................................................................................................•--..................---.....----------..........................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes ❑ No
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. , Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Onh'
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.violations•or. deficiencies. were noted during this visit. -You-will receive no further
correspondence; about this visit::
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
done as a follow up. Due to freeboard still being less than adequate a Notice of Referral will be sent to DWQ-WiRO.
discussion with Mr. Miller involved the fact that he had gotten the original freeboard problem in compliance. However the other
goon was now out of compliance. I advised that this was a farm management issue for managing the freeboard in all of his
7/25/97
a
Reviewer/Inspector Name John M. Fitzgerald
Reviewer/Inspector Signature: Date:
Farility NumhPrc i1-290 1 1! 1

le Routine O Complaint O Follow-up of DW2 inspection O Follow-up of DSWC review O Other
Date of Inspection 61 it
Facility Number
Time of Inspection ULatl24 hr. (hh:rtim)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review
❑ Certified 0 Permitted jor Inspection Cincludes travel and processing)
❑ Not Operational Date Last Operated: _ .. _ ......_ ....M.... .....- ....... ..............__....__.... _.....................
Farm Name: .k aCS...i� �.� ! �..�Ear i. N S.t..l Z!'_........_ County:.u.
LandOwner Namee:... ._....... .......... _. ..... Phone No: .�..__.....
�...._.--
Facility
Conctact: Title: ..:.. _ ... _ ... Phone No: ...._ ...._ ..... ...... ..__......
0 � �
Mailing Address, r ? -. St....
Onsite Representative:Integrator:
Certified Operator: ... ...._._..... _ ......_...... Operator Certification Number: —.— . ... . .... .. ,
Location of Farm:
Ka.. S z.M.;l,...,5 �. i._L�. Q rn. .►.�r�.sa _ �Q..:5e....
r-� -
!N:.y..25-1......Y1t-r.+.....r..i h.t.....�xL... .' �.i�... � .r.. gin..... ! � .. :.... ............ ....... ...... __.... .....__.... �
Latitude Longitude
Type of Operation and Design Capacity
s tgni Cutrent
Design Current
x Design Current �DesN
Swine; Ca aci �i'o ulg#on �oultiyr Ca aei Po elatiCatt1e�Ci pac 01DUlahon'
�$ Wean to Feeder S3�1J ❑ La er' ❑ Dairy
❑Feeder to Finish❑ Non -La er ❑ Nan Da
Farrow to Wean fir, # %
Farrow to Feeder Total Deslgn,Capaetty Sz&v
Farrow to Finish��
� -
❑ �
:.ate' . ✓ *n-
Oche[
Number ofLagoons,JNH,-ldmg Porids � ❑Subsurface Drams PresentJA
[ a
x goon Area Spray Fie d Area ; ❑ La ra
Gen
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes ® No
❑ Yes 10 No
❑ Yes N No
❑ Yes Eq No
❑ Yes ® No
❑ Yes 29 No
❑ Yes 0 No
❑ Yes ® No
Continued on back
Wt

Facility Number:...}......
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons an_dlor Holding. Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
i.x ..... ._ .i.L��...... ...... -........ _......
10. Is seepage observed from any of the structures?
❑ Yes J@ No
❑ Yes ®No
❑ Yes No
❑ Yes I No
Structure 4 Structure 5 Structure 6
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ......... --. _........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For eMified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes M No
❑ Yes 0 No
g@ Yes ❑ No
❑ Yes ®No
❑ Yes ® No
IR Yes ❑ No
❑ Yes [H No
® Yes ❑ No
❑ Yes No
❑ Yes El No
❑ Yes M No
❑ Yes ffi No
❑ Yes 0 No
JR Yes ❑ No
Comrrients'(refer to'question' Explain any YES answers'and/or`any recornmendatFons or any other comments' "
Use dratRnngs; of facility to better explain s�tiiatxons';(use additional^:pages as necessary) �€ -� � 4 � � ` - �' � r
il. Mew ihy.w WO-1I c i oo�s-P �ede�eL a+�• 0�
o� `� ba.�c SF0t-k
0
la oaw. wo- l ►s • V
1 b. �e S cu e i S b 0- 1 q +-n us � s v. S" e th • 'T1�► - I C'V r n e q4t �e
10 D + C. % CL l +rL Cie r O v"a- � i, a � e & AA_ l VIA- CL
(g . V3 Q Y h La Y Yh 9- C f r t/V e W
�C'j
�V ✓. iit-E V-- C r L+-44 ; � � 0� 0 J � P tc4.�n /
c 1 J0
Reviewer/Inspector Name , ` ems' 27
xT
Reviewer/Inspector Signature: Date: 1jjj
cc. Division of Water Oualitv. Water Oualitv Section. Facilitv Assessment Urvit 4/30/97

State of North Carolina
Department of Environment,
Health and Natural Resources
James B. Hunt, Jr., Governor
Jonathan B: Howes, Secretary
November 13, 1996
Michael Miller
Pigs-R-Us/Miller's Nursery
2582 E NC 24
Beulaville NC 28518
SUBJECT: Operator In Charge Designation
Facility: Pigs-R-Us/Miller's Nursery
Facility ID#: 31-290
Duplin County
lM�un►T1i_f17;
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study
Commission on Agricultural Waste, enacted by the 1996 North Carolina General Assembly,
requires a certified operator for each animal waste management system that serves 250 or more
swine by January 1, 1997. The owner of each animal waste management system must submit a
designation form to the Technical Assistance and Certification Group which designates an
Operator in Charge and is countersigned by the certified operator. The enclosed form must be
submitted by January 1, 1997 for all facilities in operation as of that date. Failure to designate a
certified operator for your animal waste management system is a violation of 15A NCAC 2H
.0224 and may result in the assessment of a civil penalty.
If you have questions concerning operator training or examinations for certification, please
contact your local North Carolina Cooperative Extension Service agent or our office.
Examinations have been offered on an on -going basis in many counties throughout the state for
the past several months and will continue to be offered through December 31, 1996.
Thank you for your cooperation. If you have any questions concerning this requirement please
call Beth Buffington or Barry Huneycutt of our staff at 91gn33-0026.
Sincerely,
72
A. Preston Howard, Jr., P.E., Director
Division of Water Quality
Enclosure
cc: Wilmington Regional Office
Water Quality Files
P.O. Box 27687. NvfCAn
Raleigh, North Carolina 27611 7687 Equal Opportunity/Affirmative Action Employer
Voice 919-715-4100 50% recycled/10% post -consumer paper

�J
Site Requires Immediate Attention:
Facility No. 05%
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANEVIAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
)&cX41 ll��G Time: ��
Farm Name/Owner:! y: �`�//''L r�
Mailing Address: 110 `J O /5 C)
County:
Integrator Ll
On Site Representative: 1 M.
Physical Address/Location: G % / Q
Phone: 12 7 oC / / /
Phone: ,l 164919 6_23 k2lc-1_19
Type of Operation: Swine SZ Poultry Cattle
Design Capacity: Q Number of Animals on Site:
DEM Certification Number: ACE DEM Ce 'fcation Number: ACNEW
Latitude:`'" Longitude: r ' 2" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) or No tual Freeboard: �Ft. Inches
Was any seepage observed from the la oon(s)? Yes o N Was any erosion observed? Yes or/'No j
Is adequate land available for spra ? es or No Is the cover crop adequate?Bor No �/
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings or No
100 Feet from Wells? Ue 1or o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(9
Is animal waste Iand applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o)
Is animal waste discharged into waters e state by man-made ditch, flushing system, or other
similar man-made devices? Yes or o If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with Fover crop)? Yes or
Comments:
17 , r !,(;
Inspector Name
ature
cc: Facility Assessment Unit
Use Attachments if Needed.

OPERATIONS BRANCH - WQ Fax:[phone]
Jul 20 '95 19:18 P.04115
0
11
Site Requires Immediate Attention
Facility Number,
SITE VISITATiQN RECORD
DATE: _ �..��J0 0 - 1995
owner: i� G:&A � i' Varm Name:
County: O I t 4.
Agent Visiting Site:` Phone: 2
Operator Phone:
On Site Representative: phone:
Physical Address: N e, ^jr? t v a
Mailing Addresa:
Type of Operation: Swine Poultry Catdr,
Design Capacity: P it) 11 Number of'Aairnals on Site: i5-6
Latitude: e Longitude: _______0
Type of Inspection: G.roand _ Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 incites) Yes or No Actual Freeboard: _L Feet � �Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes o No Was there erosion of the. dam?: Yes or No
Is adequate land available for laird application? Yes or No Is the cover crop adequate? Yes or No
Additional Comments:
Fax to [phone] Sim ature of Agent

Site Requires Immediate Attention:
Facility
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1 ; , 1995
Time: 2-
Farm Name/Owner: f'"i',
Mailing Address: ,9`Z C 2
County:
Integrator: Y Phone: `j ` !1 l
On Site Representative: Phone: / 00 9 7 7 544?
Physical Address/Location: _/yG,y_ 2z a _
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity:
Number of Animals on Site:
DEM Certiftc tion Number: ACE DEM Certificati Number. ACNEW
Latitude: Longitude:° Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have fficient freeboard of 1 Foot + 25 year. 24 hour storm event
(approximately 1 Foot + 7 inches) or No Actual Freeboard:Ft. Inches
• Was any seepage observed from the la on(s}? Yes or� Was arty erosion obsery d? Yes or t T
Is adequate land available for spy? '}e or No Is the cover crop adequate? es r No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? e or No
100 Feet from Wells? e or o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes org)
Is animal waste discharged into waters of e state by man-made ditch, flushing system, or other
similar man-made devices? Yes or o If Yes, Please Explain.
Does the facility maintain adequate waste management records (voj{tmes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or o
Additional Comment ya i S ✓'
Y
Inspector Name S
cc: Facility Assessment Unit Use Attachments if Needed.